Kristen E Elstner1,2, John W Read3, Anita S W Jacombs1,2, Rodrigo Tomazini Martins2, Fernando Arduini2, Peter H Cosman1,2, Omar Rodriguez-Acevedo2, Anthony N Dardano4, Alex Karatassas5, Nabeel Ibrahim6,7,8. 1. Macquarie University Hospital, Technology Place, Macquarie, Australia. 2. Hernia Institute Australia, Edgecliff, Australia. 3. Macquarie Medical Imaging, Macquarie University Hospital, Technology Place, Macquarie, Australia. 4. Boca Raton Regional Hospital, Boca Raton, FL, USA. 5. Discipline of Surgery, University of Adelaide, Adelaide, Australia. 6. Macquarie University Hospital, Technology Place, Macquarie, Australia. docnibrahim@gmail.com. 7. Hernia Institute Australia, Edgecliff, Australia. docnibrahim@gmail.com. 8. , Level 3, Suite 313, 203-233 New South Head Road, Edgecliff, NSW, 2027, Australia. docnibrahim@gmail.com.
Abstract
BACKGROUND: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. METHODS: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. RESULTS: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. CONCLUSIONS: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.
BACKGROUND: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. METHODS: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. RESULTS: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. CONCLUSIONS: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.
Authors: Sylvester M Maas; ReilinghTammo S de Vries; Harry van Goor; Dick de Jong; Robert P Bleichrodt Journal: J Am Coll Surg Date: 2002-03 Impact factor: 6.113
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Authors: K E Elstner; A S W Jacombs; J W Read; O Rodriguez; M Edye; P H Cosman; A N Dardano; A Zea; T Boesel; D J Mikami; C Craft; N Ibrahim Journal: Hernia Date: 2016-03-07 Impact factor: 4.739
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